Nurse Claims Analyst
Brightwater
Cork
Nurse Claims Analyst. Our client a leader in the Insurance Industry is looking for an experienced General Nurse with strong administration skills to join their growing professional team. The successful candidate will ensure management of claims medical costs in line with best practice through utilisation review and collaborating and meeting with providers. Provide medical support and advice to the business where required. The primary function will be reviewing claims to ensure efficiency and cost containment and making decisions on claims utilisation following evaluation of medical guidelines and benefit determination. Attend meetings to communicate and educate hospital personnel and consultants on the importance of managing patients efficiently in line with best practice. Desirable personal qualities include the ability to work under pressure, pay attention to detail, tolerance for reviewing, analysing and interpreting data and be a confident decision maker. Good communication skills and presentation skills are necessary. Responsibilities: • Retrospective Clinical Evaluation of Claims to ensure treatment was carried out in the appropriate setting with an appropriate Length of Stay. • Involved in setting of fees in the Schedule of Procedures for Professional fees. • Provide Clinical training to non -clinical personnel. • Provide Clinical advice and support to the Business. • Attendance at meetings with hospital and consultants. • Liaise with Clinicians on a daily basis. • Responsibility for reporting and analysing practice in Claims Activity. • Update monthly reports on utilisation review. • Draft letters, papers and presentations in relation to the clinical area as required. • Awareness to market changes in the medical field. • Completion of any ad hoc duties which may be requested as part of the daily running of the Medical Practice Team. Requirements: • Registered General Nurse. • Min 3 years hands on clinical experience. • Strong administrative skills. • Strong Computer Skills. • Excellent presentation skills. • Confident with strong communication skills both written and verbal. • Strong negotiating ability. • Ability to analyse data and contribute to process improvement. What are the BENEFITS? • Strong salary and excellent benefits and bonus. • Strong brand. • Growing company. • Work life balance. This job originally appeared on RecruitIreland.com.
2268 days ago